{"id":1386,"date":"2024-02-20T07:58:25","date_gmt":"2024-02-20T07:58:25","guid":{"rendered":"https:\/\/roadmaptojesus.org\/?page_id=1386"},"modified":"2024-02-20T10:28:09","modified_gmt":"2024-02-20T10:28:09","slug":"questionnaire","status":"publish","type":"page","link":"https:\/\/roadmaptojesus.org\/pt\/questionnaire\/","title":{"rendered":"QUESTIONNAIRE"},"content":{"rendered":"<div data-elementor-type=\"wp-post\" data-elementor-id=\"1386\" class=\"elementor elementor-1386\" data-elementor-post-type=\"page\">\n\t\t\t\t<div class=\"elementor-element elementor-element-36e4911 e-flex e-con-boxed e-con e-parent\" data-id=\"36e4911\" data-element_type=\"container\" data-e-type=\"container\" data-settings=\"{&quot;background_background&quot;:&quot;classic&quot;}\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-8d332cf e-con-full e-flex e-con e-child\" data-id=\"8d332cf\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-4bf79de elementor-widget elementor-widget-heading\" data-id=\"4bf79de\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\">VISIT US - QUESTIONNAIRE <\/h1>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0c901ab e-flex e-con-boxed e-con e-parent\" data-id=\"0c901ab\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t<div class=\"elementor-element elementor-element-b71e4eb e-con-full e-flex e-con e-child\" data-id=\"b71e4eb\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t<div class=\"elementor-element elementor-element-3c525f0 elementor-widget-divider--view-line_text elementor-widget-divider--element-align-left elementor-widget elementor-widget-divider\" data-id=\"3c525f0\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"divider.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-divider\">\n\t\t\t<span class=\"elementor-divider-separator\">\n\t\t\t\t\t\t\t<h6 class=\"elementor-divider__text elementor-divider__element\">\n\t\t\t\tVISIT US QUESTIONNAIRE\t\t\t\t<\/h6>\n\t\t\t\t\t\t<\/span>\n\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-52d103b elementor-widget elementor-widget-image-box\" data-id=\"52d103b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"image-box.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"elementor-image-box-wrapper\"><div class=\"elementor-image-box-content\"><h2 class=\"elementor-image-box-title\">ROAD MAP TO JESUS INTERNATIONAL MINISTRIES<\/h2><p class=\"elementor-image-box-description\">To visit The Roadmap to Jesus International Ministry, kindly complete the questionnaire provided and submit it. Your detailed responses will help us effectively handle your request. Most communication regarding your visit will be conducted via email and WhatsApp. Please await confirmation from us before making any travel plans.<\/p><\/div><\/div>\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d936f6a elementor-align-center elementor-widget elementor-widget-button\" data-id=\"d936f6a\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"button.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t\t\t<div class=\"elementor-button-wrapper\">\n\t\t\t\t\t<a class=\"elementor-button elementor-button-link elementor-size-xl\" href=\"https:\/\/roadmaptojesus.org\/pt\/partnership\/\">\n\t\t\t\t\t\t<span class=\"elementor-button-content-wrapper\">\n\t\t\t\t\t\t\t\t\t<span class=\"elementor-button-text\">become of partner today!<\/span>\n\t\t\t\t\t<\/span>\n\t\t\t\t\t<\/a>\n\t\t\t\t<\/div>\n\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-346bb0b elementor-pagination-position-outside elementor-widget elementor-widget-image-carousel\" data-id=\"346bb0b\" data-element_type=\"widget\" data-e-type=\"widget\" data-settings=\"{&quot;slides_to_show&quot;:&quot;3&quot;,&quot;slides_to_scroll&quot;:&quot;1&quot;,&quot;navigation&quot;:&quot;dots&quot;,&quot;slides_to_show_tablet&quot;:&quot;2&quot;,&quot;slides_to_show_mobile&quot;:&quot;1&quot;,&quot;autoplay&quot;:&quot;no&quot;,&quot;infinite&quot;:&quot;yes&quot;,&quot;speed&quot;:500,&quot;image_spacing_custom&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:20,&quot;sizes&quot;:[]},&quot;image_spacing_custom_tablet&quot;:{&quot;unit&quot;:&quot;px&quot;,&quot;size&quot;:&quot;&quot;,&quot;sizes&quot;:[]}}\" data-widget_type=\"image-carousel.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t\t\t<div class=\"elementor-image-carousel-wrapper swiper\" role=\"region\" aria-roledescription=\"carousel\" aria-label=\"Image Carousel\" dir=\"ltr\">\n\t\t\t<div class=\"elementor-image-carousel swiper-wrapper swiper-image-stretch\" aria-live=\"polite\">\n\t\t\t\t\t\t\t\t<div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"1 of 4\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/roadmaptojesus.org\/wp-content\/uploads\/2024\/02\/ROADMAP.webp\" alt=\"ROADMAP\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"2 of 4\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/roadmaptojesus.org\/wp-content\/uploads\/2024\/02\/ROADMAP-2.webp\" alt=\"ROADMAP 2\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"3 of 4\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/roadmaptojesus.org\/wp-content\/uploads\/2024\/02\/ROADMAP-3.webp\" alt=\"ROADMAP 3\" \/><\/figure><\/div><div class=\"swiper-slide\" role=\"group\" aria-roledescription=\"slide\" aria-label=\"4 of 4\"><figure class=\"swiper-slide-inner\"><img decoding=\"async\" class=\"swiper-slide-image\" src=\"https:\/\/roadmaptojesus.org\/wp-content\/uploads\/2024\/02\/ROADMAP-4.webp\" alt=\"ROADMAP 4\" \/><\/figure><\/div>\t\t\t<\/div>\n\t\t\t\t\t\t\t\n\t\t\t\t\t\t\t\t\t<div class=\"swiper-pagination\"><\/div>\n\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t<div class=\"elementor-element elementor-element-0b6c783 e-flex e-con-boxed e-con e-parent\" data-id=\"0b6c783\" data-element_type=\"container\" data-e-type=\"container\">\n\t\t\t\t\t<div class=\"e-con-inner\">\n\t\t\t\t<div class=\"elementor-element elementor-element-c643d8b elementor-widget elementor-widget-wpforms\" data-id=\"c643d8b\" data-element_type=\"widget\" data-e-type=\"widget\" data-widget_type=\"wpforms.default\">\n\t\t\t\t<div class=\"elementor-widget-container\">\n\t\t\t\t\t<div class=\"wpforms-container wpforms-container-full  Make submit button full width  your-submit-button-class  width 100  wpforms-render-modern\" id=\"wpforms-1430\"><form id=\"wpforms-form-1430\" class=\"wpforms-validate wpforms-form wpforms-ajax-form\" data-formid=\"1430\" method=\"post\" enctype=\"multipart\/form-data\" action=\"\/pt\/wp-json\/wp\/v2\/pages\/1386\" data-token=\"cf90e47e31928dc566206fe1eed57c4f\" data-token-time=\"1776951912\" data-trp-original-action=\"\/pt\/wp-json\/wp\/v2\/pages\/1386\"><div class=\"wpforms-head-container\"><div class=\"wpforms-title\">Questionnaire Form<\/div><\/div><noscript class=\"wpforms-error-noscript\">Please enable JavaScript in your browser to complete this form.<\/noscript><div id=\"wpforms-error-noscript\" style=\"display: none;\">Please enable JavaScript in your browser to complete this form.<\/div><div class=\"wpforms-field-container\"><div id=\"wpforms-1430-field_0-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"0\"><fieldset><legend class=\"wpforms-field-label\">Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/legend><div class=\"wpforms-field-row wpforms-field-large\"><div class=\"wpforms-field-row-block wpforms-first wpforms-one-half\"><input type=\"text\" id=\"wpforms-1430-field_0\" class=\"wpforms-field-name-first wpforms-field-required\" name=\"wpforms[fields][0][first]\" aria-errormessage=\"wpforms-1430-field_0-error\" required><label for=\"wpforms-1430-field_0\" class=\"wpforms-field-sublabel after\">First<\/label><\/div><div class=\"wpforms-field-row-block wpforms-one-half\"><input type=\"text\" id=\"wpforms-1430-field_0-last\" class=\"wpforms-field-name-last wpforms-field-required\" name=\"wpforms[fields][0][last]\" aria-errormessage=\"wpforms-1430-field_0-last-error\" required><label for=\"wpforms-1430-field_0-last\" class=\"wpforms-field-sublabel after\">Last<\/label><\/div><\/div><\/fieldset><\/div><div id=\"wpforms-1430-field_3-container\" class=\"wpforms-field wpforms-field-select wpforms-field-select-style-classic\" data-field-id=\"3\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_3\">Gender<\/label><select id=\"wpforms-1430-field_3\" class=\"wpforms-field-large\" name=\"wpforms[fields][3]\"><option value=\"Female\"  class=\"choice-1 depth-1\"  >Female<\/option><option value=\"Male\"  class=\"choice-2 depth-1\"  >Male<\/option><\/select><\/div><div id=\"wpforms-1430-field_5-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"5\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_5\">Nationality<\/label><input type=\"text\" id=\"wpforms-1430-field_5\" class=\"wpforms-field-large\" name=\"wpforms[fields][5]\" aria-errormessage=\"wpforms-1430-field_5-error\" ><\/div><div id=\"wpforms-1430-field_6-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"6\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_6\">Country of Residence<\/label><input type=\"text\" id=\"wpforms-1430-field_6\" class=\"wpforms-field-large\" name=\"wpforms[fields][6]\" aria-errormessage=\"wpforms-1430-field_6-error\" ><\/div><div id=\"wpforms-1430-field_7-container\" class=\"wpforms-field wpforms-field-text\" data-field-id=\"7\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_7\">Profession<\/label><input type=\"text\" id=\"wpforms-1430-field_7\" class=\"wpforms-field-large\" name=\"wpforms[fields][7]\" aria-errormessage=\"wpforms-1430-field_7-error\" ><\/div><div id=\"wpforms-1430-field_1-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"1\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_1\">Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1430-field_1\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][1]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1430-field_1-error\" required><\/div><div id=\"wpforms-1430-field_9-container\" class=\"wpforms-field wpforms-field-name\" data-field-id=\"9\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_9\">Relative Name <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"text\" id=\"wpforms-1430-field_9\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][9]\" aria-errormessage=\"wpforms-1430-field_9-error\" required><\/div><div id=\"wpforms-1430-field_8-container\" class=\"wpforms-field wpforms-field-number\" data-field-id=\"8\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_8\">Relative Numbers<\/label><input type=\"number\" id=\"wpforms-1430-field_8\" class=\"wpforms-field-large\" name=\"wpforms[fields][8]\" step=\"any\" aria-errormessage=\"wpforms-1430-field_8-error\" ><\/div><div id=\"wpforms-1430-field_10-container\" class=\"wpforms-field wpforms-field-email\" data-field-id=\"10\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_10\">Relative Email <span class=\"wpforms-required-label\" aria-hidden=\"true\">*<\/span><\/label><input type=\"email\" id=\"wpforms-1430-field_10\" class=\"wpforms-field-large wpforms-field-required\" name=\"wpforms[fields][10]\" spellcheck=\"false\" aria-errormessage=\"wpforms-1430-field_10-error\" required><\/div><div id=\"wpforms-1430-field_11-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"11\"><fieldset><legend class=\"wpforms-field-label\">Are you having any sickness?<\/legend><ul id=\"wpforms-1430-field_11\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_11_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][11][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_11_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_11_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_11_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][11][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_11_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_11_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_2-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"2\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_2\">Please state the nature of the problem you are having and all the symptoms<\/label><textarea id=\"wpforms-1430-field_2\" class=\"wpforms-field-medium\" name=\"wpforms[fields][2]\" aria-errormessage=\"wpforms-1430-field_2-error\" ><\/textarea><\/div><div id=\"wpforms-1430-field_12-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"12\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_12\">Please specify in detail<\/label><textarea id=\"wpforms-1430-field_12\" class=\"wpforms-field-medium\" name=\"wpforms[fields][12]\" aria-errormessage=\"wpforms-1430-field_12-error\" ><\/textarea><\/div><div id=\"wpforms-1430-field_13-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"13\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_13\">For how long have you been experiencing this problem?<\/label><textarea id=\"wpforms-1430-field_13\" class=\"wpforms-field-medium\" name=\"wpforms[fields][13]\" aria-errormessage=\"wpforms-1430-field_13-error\" ><\/textarea><\/div><div id=\"wpforms-1430-field_14-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"14\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_14\">List all the medications you are taking or have taken due to this problem or condition.<\/label><textarea id=\"wpforms-1430-field_14\" class=\"wpforms-field-medium\" name=\"wpforms[fields][14]\" aria-errormessage=\"wpforms-1430-field_14-error\" ><\/textarea><\/div><div id=\"wpforms-1430-field_15-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"15\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_15\">How has the problem or condition affected your daily living?<\/label><textarea id=\"wpforms-1430-field_15\" class=\"wpforms-field-medium\" name=\"wpforms[fields][15]\" aria-errormessage=\"wpforms-1430-field_15-error\" ><\/textarea><\/div><div id=\"wpforms-1430-field_16-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"16\"><fieldset><legend class=\"wpforms-field-label\">Have you ever been hospitalized? If yes when?<\/legend><ul id=\"wpforms-1430-field_16\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_16_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][16][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_16_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_16_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_16_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][16][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_16_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_16_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_17-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"17\"><fieldset><legend class=\"wpforms-field-label\">If you are HIV positive, please indicate your status (All HIV patients need to come with their most recent original printed HIV confirmatory report when their visit is confirmed. Please note that no screening report will be accepted, only a confirmatory report that clearly states that this patient is HIV I, II OR III positive, and it must be typed on the hospital&#039;s letterhead. It must be a government-recognized hospital in your country. You cannot come without the correct medical report.) Are you using any form of brace?<\/legend><ul id=\"wpforms-1430-field_17\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_17_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][17][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_17_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_17_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_17_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][17][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_17_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_17_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_18-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"18\"><fieldset><legend class=\"wpforms-field-label\">Are you using any form of walking aid (crutch, stick, etc.) or a wheelchair?<\/legend><ul id=\"wpforms-1430-field_18\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_18_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][18][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_18_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_18_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_18_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][18][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_18_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_18_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_19-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"19\"><fieldset><legend class=\"wpforms-field-label\">Are you using any medical device to support your health condition?<\/legend><ul id=\"wpforms-1430-field_19\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_19_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][19][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_19_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_19_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_19_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][19][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_19_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_19_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_20-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"20\"><fieldset><legend class=\"wpforms-field-label\">Are you limping?<\/legend><ul id=\"wpforms-1430-field_20\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_20_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][20][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_20_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_20_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_20_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][20][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_20_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_20_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_21-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"21\"><fieldset><legend class=\"wpforms-field-label\">Do you still go about your daily activities normally without using any aids or assistance from other people?<\/legend><ul id=\"wpforms-1430-field_21\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_21_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][21][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_21_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_21_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_21_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][21][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_21_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_21_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_22-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"22\"><fieldset><legend class=\"wpforms-field-label\">Can you walk normally or climb stairs without assistance?<\/legend><ul id=\"wpforms-1430-field_22\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_22_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][22][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_22_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_22_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_22_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][22][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_22_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_22_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_23-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"23\"><fieldset><legend class=\"wpforms-field-label\">Do you experience body weakness?<\/legend><ul id=\"wpforms-1430-field_23\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_23_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][23][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_23_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_23_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_23_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][23][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_23_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_23_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_24-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"24\"><fieldset><legend class=\"wpforms-field-label\">Have you had any surgery or other therapy as a result of the problem\/ condition? If yes, please give details<\/legend><ul id=\"wpforms-1430-field_24\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_24_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][24][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_24_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_24_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_24_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][24][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_24_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_24_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_27-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"27\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_27\">Is any part of your body swollen? If yes, where?<\/label><textarea id=\"wpforms-1430-field_27\" class=\"wpforms-field-medium\" name=\"wpforms[fields][27]\" aria-errormessage=\"wpforms-1430-field_27-error\" ><\/textarea><\/div><div id=\"wpforms-1430-field_28-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"28\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_28\">Do you have any open wound? If yes, where?<\/label><textarea id=\"wpforms-1430-field_28\" class=\"wpforms-field-medium\" name=\"wpforms[fields][28]\" aria-errormessage=\"wpforms-1430-field_28-error\" ><\/textarea><\/div><div id=\"wpforms-1430-field_29-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"29\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_29\">Are you on a special diet as a result of your sickness or problem? If yes, please state the details<\/label><textarea id=\"wpforms-1430-field_29\" class=\"wpforms-field-medium\" name=\"wpforms[fields][29]\" aria-errormessage=\"wpforms-1430-field_29-error\" ><\/textarea><\/div><div id=\"wpforms-1430-field_30-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"30\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_30\">Do you have any other sickness or problems? If yes, please list all symptoms, treatments, and medications<\/label><textarea id=\"wpforms-1430-field_30\" class=\"wpforms-field-medium\" name=\"wpforms[fields][30]\" aria-errormessage=\"wpforms-1430-field_30-error\" ><\/textarea><\/div><div id=\"wpforms-1430-field_25-container\" class=\"wpforms-field wpforms-field-checkbox\" data-field-id=\"25\"><fieldset><legend class=\"wpforms-field-label\">Do you intend to come alone or accompanied? (If you will be accompanied, please ask each of those with you to also submit this questionnaire, indicating in the comments section that they intend to come with you)<\/legend><ul id=\"wpforms-1430-field_25\" data-choice-limit=\"1\"><li class=\"choice-1 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_25_1\" data-rule-check-limit=\"true\" name=\"wpforms[fields][25][]\" value=\"Yes\" aria-errormessage=\"wpforms-1430-field_25_1-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_25_1\">Yes<\/label><\/li><li class=\"choice-2 depth-1\"><input type=\"checkbox\" id=\"wpforms-1430-field_25_2\" data-rule-check-limit=\"true\" name=\"wpforms[fields][25][]\" value=\"No\" aria-errormessage=\"wpforms-1430-field_25_2-error\"  ><label class=\"wpforms-field-label-inline\" for=\"wpforms-1430-field_25_2\">No<\/label><\/li><\/ul><\/fieldset><\/div><div id=\"wpforms-1430-field_31-container\" class=\"wpforms-field wpforms-field-textarea\" data-field-id=\"31\"><label class=\"wpforms-field-label\" for=\"wpforms-1430-field_31\">How did you hear about The Roadmap to Jesus International Ministry?<\/label><textarea id=\"wpforms-1430-field_31\" class=\"wpforms-field-medium\" name=\"wpforms[fields][31]\" aria-errormessage=\"wpforms-1430-field_31-error\" ><\/textarea><\/div><\/div><!-- .wpforms-field-container --><div class=\"wpforms-submit-container\" ><input type=\"hidden\" name=\"wpforms[id]\" value=\"1430\"><input type=\"hidden\" name=\"page_title\" value=\"\"><input type=\"hidden\" name=\"page_url\" value=\"https:\/\/roadmaptojesus.org\/pt\/wp-json\/wp\/v2\/pages\/1386\"><input type=\"hidden\" name=\"url_referer\" value=\"\"><button type=\"submit\" name=\"wpforms[submit]\" id=\"wpforms-submit-1430\" class=\"wpforms-submit\" data-alt-text=\"Sending...\" data-submit-text=\"Submit\" aria-live=\"assertive\" value=\"wpforms-submit\">Submit<\/button><img decoding=\"async\" src=\"https:\/\/roadmaptojesus.org\/wp-content\/plugins\/wpforms-lite\/assets\/images\/submit-spin.svg\" class=\"wpforms-submit-spinner\" style=\"display: none;\" width=\"26\" height=\"26\" alt=\"Loading\"><\/div><input type=\"hidden\" name=\"trp-form-language\" value=\"pt\"\/><\/form><\/div>  <!-- .wpforms-container -->\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\t\t\t\t<\/div>","protected":false},"excerpt":{"rendered":"<p>VISIT US &#8211; QUESTIONNAIRE VISIT US QUESTIONNAIRE ROAD MAP TO JESUS INTERNATIONAL MINISTRIES To visit The Roadmap to Jesus International Ministry, kindly complete the questionnaire provided and submit it. Your detailed responses will help us effectively handle your request. Most communication regarding your visit will be conducted via email and WhatsApp. Please await confirmation from [&hellip;]<\/p>","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"site-sidebar-layout":"no-sidebar","site-content-layout":"page-builder","ast-site-content-layout":"full-width-container","site-content-style":"unboxed","site-sidebar-style":"unboxed","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"disabled","ast-breadcrumbs-content":"","ast-featured-img":"disabled","footer-sml-layout":"","ast-disable-related-posts":"","theme-transparent-header-meta":"enabled","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"set","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"class_list":["post-1386","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/roadmaptojesus.org\/pt\/wp-json\/wp\/v2\/pages\/1386","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/roadmaptojesus.org\/pt\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/roadmaptojesus.org\/pt\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/roadmaptojesus.org\/pt\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/roadmaptojesus.org\/pt\/wp-json\/wp\/v2\/comments?post=1386"}],"version-history":[{"count":0,"href":"https:\/\/roadmaptojesus.org\/pt\/wp-json\/wp\/v2\/pages\/1386\/revisions"}],"wp:attachment":[{"href":"https:\/\/roadmaptojesus.org\/pt\/wp-json\/wp\/v2\/media?parent=1386"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}